DCCSS: A meta-model for dynamic clinical checklist support systems

Clinical safety checklists receive much research attention since they can reduce medical errors and improve patient safety. Computerized checklist support systems are also being developed actively. Such systems should individualize checklists based on information from the patient's medical record while also considering the context of the clinical workflows. Unfortunately, the form definitions, database queries and workflow definitions related to dynamic checklists are too often hard-coded in the source code of the support systems. This increases the cognitive effort for the clinical stakeholders in the design process, it complicates the sharing of dynamic checklist definitions as well as the interoperability with other information systems. In this paper, we address these issues by contributing the DCCSS meta-model which enables the model-based development of dynamic checklist support systems. DCCSS was designed as an incremental extension of standard meta-models, which enables the reuse of generic model editors in a novel setting. In particular, DCCSS integrates the Business Process Model and Notation (BPMN) and the Guideline Interchange Format (GLIF), which represent best of breed languages for clinical workflow modeling and clinical rule modeling respectively. We also demonstrate one of the use cases where DCCSS has already been applied in a clinical setting.